Drs firing patients

[Anonymous]

Anonymous wrote:There's a doc I've encountered twice, one for myself and once when a family member was hospitalized. On one of those occasions, he was pleasant, professional, and efficient. On another--maybe he was having a bad day, I don't know--he was impatient and then became extremely unprofessional --got into an argument with the patient about something the doc was objectively incorrect about and the patient was correct--EMR was consistent as well with the patient's info, then when patient disagreed the doc bizarrely said he was going to prove he was right by calling the patient's designated proxy, which escalated the argument; in the end the doctor fired the patient in the hospital and another attending took his place but it was the patient, not the doctor, who was labeled as "difficult." Unfortunately, this label followed the patient, who ended up changing his insurance to get away from the network where this occurred.

How about we agree--doctors have hard jobs (not, actually, all of them, but enough of them). Patients have hard jobs--while they are sick or hurt they ALSO have the "job" of managing life, insurance, and the universe (today, after several months of repeated days off trying to sort out helping someone get a procedure which implicates several medical conditions, involving 3 different provider networks, and trying to get a handle on getting insurance authorization, I ended up pretty much where we were 5 months ago. I've learned some facts that I couldn't have known before, but it still means tackling the entire business again, and is going to involve repeat visits to various specialists since so much time has passed trying to make this happen).

Increasingly I get the sense that doctors and patients are adversaries.

To some degree I think the "trust" thing has a lot of unfortunate carryover from traditions that disappeared with the horse and buggy. Back then, the doctor was the person who knew who had syphilis, who got pregnant outside of wedlock, who was a secret alcoholic, who had confessed things that weren't even medical in nature because a doctor was like a priest. (Of course, in today's political climate, we might be headed back there.)

This is very much less the case. The argument has been made for decades by some that healthcare should be based on market principles and consumers (not "patients") should be shopping around for the best deal in terms of cost and quality. Not only has the internet spawned customer service ratings, but corporate healthcare has also jumped on that as well (a family member had 144 medical appointments in 2022, including tests and therapies, every damn one of them meant a robocall from their customer survey people). For a large number of people, medical care is routine--minor illnesses and injuries and screenings. The concept of a sacred trust does not come into play except in terms of HIPAA rules and ordinary professional standards. For another segment of people, medical care is a very large part of their lives. Because scope of practice is increasingly limited, they see many more different doctors and are much less likely to have a single physician to shepherd them through all this. Marcus Welby (showing my age) would pop into the hospital to see his patient even though he was not their attending physician. That's not a thing for most people.

When it gets to be adversarial most of the time it is individual battle zones--the patient who fires doctors, the doctors who fire patients, the doctors fearing lawsuits (which very rarely end up favoring patients anyway, don't help patients with terrible outcomes that could not be helped, and only rarely are the vehicle to get rid of incompetent or unethical doctors). NONE of this is healthy for any of us.

I agree with all of this. As a doctor, I started off medical school very much empathetic and a bleeding heart but the way things are now - the constant churning of patients, the lack of continuity, the billing demands, the system that puts unrealistic expectations, and patients who want more from us despite administrators shrinking the time we have available for each patient- I started to burn out and lose that part of me. My only way of coping is to work very part time (contributing to the shortage). Not sure what the answer is but it’s sad that everyone thinks of blame doctors and not fight together to change the system that is oppressing but doctors and patients.

[Anonymous]

*both doctors and patients.

[Anonymous]

This whole conversation has me wondering if I am an "ideal" patient as I have Medicare and full secondary insurance. I see that Medicare only pays about 1/3 of any dr bill, while my secondary pays the rest. I know a lot of people who have Medicare only or Medicare Advantage which really limits who they can see and it's been very tough to watch. They "lose" their doctors all the
time.

[Anonymous]

This does happen when patients specificallyand politely challenge a dr's actions or plan. The dr fears liability and invokes "loss of trust." Then fires patient. Doctors panic when they know they did something that can be questioned. They also do not like being involved in complicated situations that might involve court subpoenas, such as when pediatricians treat a child whose parents are going through a litigated divorce. This may be happening more simply because of the consolidation of practices, more involvement of consultants/lawyers, etc.

[Anonymous]

everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

[Anonymous]

I had a doctor foist me onto a colleague once. She was a horrible OBGYN and made two mistakes in my care, then got defensive about it when I asked about them. Had it happened to me as an older woman I would have left the practice immediately after the first mistake.

[Anonymous]

Anonymous wrote:

Anonymous wrote:There's a doc I've encountered twice, one for myself and once when a family member was hospitalized. On one of those occasions, he was pleasant, professional, and efficient. On another--maybe he was having a bad day, I don't know--he was impatient and then became extremely unprofessional --got into an argument with the patient about something the doc was objectively incorrect about and the patient was correct--EMR was consistent as well with the patient's info, then when patient disagreed the doc bizarrely said he was going to prove he was right by calling the patient's designated proxy, which escalated the argument; in the end the doctor fired the patient in the hospital and another attending took his place but it was the patient, not the doctor, who was labeled as "difficult." Unfortunately, this label followed the patient, who ended up changing his insurance to get away from the network where this occurred.

How about we agree--doctors have hard jobs (not, actually, all of them, but enough of them). Patients have hard jobs--while they are sick or hurt they ALSO have the "job" of managing life, insurance, and the universe (today, after several months of repeated days off trying to sort out helping someone get a procedure which implicates several medical conditions, involving 3 different provider networks, and trying to get a handle on getting insurance authorization, I ended up pretty much where we were 5 months ago. I've learned some facts that I couldn't have known before, but it still means tackling the entire business again, and is going to involve repeat visits to various specialists since so much time has passed trying to make this happen).

Increasingly I get the sense that doctors and patients are adversaries.

To some degree I think the "trust" thing has a lot of unfortunate carryover from traditions that disappeared with the horse and buggy. Back then, the doctor was the person who knew who had syphilis, who got pregnant outside of wedlock, who was a secret alcoholic, who had confessed things that weren't even medical in nature because a doctor was like a priest. (Of course, in today's political climate, we might be headed back there.)

This is very much less the case. The argument has been made for decades by some that healthcare should be based on market principles and consumers (not "patients") should be shopping around for the best deal in terms of cost and quality. Not only has the internet spawned customer service ratings, but corporate healthcare has also jumped on that as well (a family member had 144 medical appointments in 2022, including tests and therapies, every damn one of them meant a robocall from their customer survey people). For a large number of people, medical care is routine--minor illnesses and injuries and screenings. The concept of a sacred trust does not come into play except in terms of HIPAA rules and ordinary professional standards. For another segment of people, medical care is a very large part of their lives. Because scope of practice is increasingly limited, they see many more different doctors and are much less likely to have a single physician to shepherd them through all this. Marcus Welby (showing my age) would pop into the hospital to see his patient even though he was not their attending physician. That's not a thing for most people.

When it gets to be adversarial most of the time it is individual battle zones--the patient who fires doctors, the doctors who fire patients, the doctors fearing lawsuits (which very rarely end up favoring patients anyway, don't help patients with terrible outcomes that could not be helped, and only rarely are the vehicle to get rid of incompetent or unethical doctors). NONE of this is healthy for any of us.

I agree with all of this. As a doctor, I started off medical school very much empathetic and a bleeding heart but the way things are now - the constant churning of patients, the lack of continuity, the billing demands, the system that puts unrealistic expectations, and patients who want more from us despite administrators shrinking the time we have available for each patient- I started to burn out and lose that part of me. My only way of coping is to work very part time (contributing to the shortage). Not sure what the answer is but it’s sad that everyone thinks of blame doctors and not fight together to change the system that is oppressing but doctors and patients.

Lets picture your ideal world. You get enough time to spend with every patient and insurance reimburses at a rate that doesn't cut your salary. Sounds great. Except your are now seeing few patients at a high cost per patient which means that everyone's insurance costs that much more. You are also seeing fewer patients, but the number of doctors hasn't increased in line with that decline, so more people either lose access to a doctor or have to wait much longer for an appointment.

[Anonymous]

Anonymous wrote:everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

I too don't think I'm paying enough for my health insurance and medicare tax. We should get together to lobby to have more of our paychecks go towards healthcare

[Anonymous]

Anonymous wrote:everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

You prefer poor people dying quietly rather than accessing healthcare?

[Anonymous]

Anonymous wrote:

Anonymous wrote:everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

You prefer poor people dying quietly rather than accessing healthcare?

no i dont. insurance companies are not passing on the increase in premiums to the system. look at the insurance company salaries, have increase dramatically in the last decade but no increases to the reimbursements. this is not a joke, the docs making 250k a year 15 years ago are still getting 250k, now does that sound right?? have you seen your salary increase in the last 15 yrs? if it didn't, where would your job satisfaction be? would you recc your job to other people so they can enter the field?? the answer is no.

All I am saying is that insurance companies are allowed to do what they want and me as a doctor and you as a patient have no control what so ever. You're pissed with the quality of care, we are pissed at you being pissed not understanding what we are going through and the insurance companies are making money hand over fist at levels not seen before.

At the end, insurance companies need to pass on the profits to the system so docs are happier, more people enter the field, more patients can be seen because we have a bigger work force and quality of care goes up.

[Anonymous]

Anonymous wrote:everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

socialism? I am not advocating for universal health care but the status quo isn't working. For profit healthcare is not working. You want to talk about quality of care going down? How about hospitals cutting corners to make money? How about terrible nurse to patient ratios to cut costs? And in order for insurance companies to survive, they deny patients (who pay for their services) necessary care. The whole thing is a freaking mess.

[Anonymous]

Anonymous wrote:There's a doc I've encountered twice, one for myself and once when a family member was hospitalized. On one of those occasions, he was pleasant, professional, and efficient. On another--maybe he was having a bad day, I don't know--he was impatient and then became extremely unprofessional --got into an argument with the patient about something the doc was objectively incorrect about and the patient was correct--EMR was consistent as well with the patient's info, then when patient disagreed the doc bizarrely said he was going to prove he was right by calling the patient's designated proxy, which escalated the argument; in the end the doctor fired the patient in the hospital and another attending took his place but it was the patient, not the doctor, who was labeled as "difficult." Unfortunately, this label followed the patient, who ended up changing his insurance to get away from the network where this occurred.

How about we agree--doctors have hard jobs (not, actually, all of them, but enough of them). Patients have hard jobs--while they are sick or hurt they ALSO have the "job" of managing life, insurance, and the universe (today, after several months of repeated days off trying to sort out helping someone get a procedure which implicates several medical conditions, involving 3 different provider networks, and trying to get a handle on getting insurance authorization, I ended up pretty much where we were 5 months ago. I've learned some facts that I couldn't have known before, but it still means tackling the entire business again, and is going to involve repeat visits to various specialists since so much time has passed trying to make this happen).

Increasingly I get the sense that doctors and patients are adversaries.

To some degree I think the "trust" thing has a lot of unfortunate carryover from traditions that disappeared with the horse and buggy. Back then, the doctor was the person who knew who had syphilis, who got pregnant outside of wedlock, who was a secret alcoholic, who had confessed things that weren't even medical in nature because a doctor was like a priest. (Of course, in today's political climate, we might be headed back there.)

This is very much less the case. The argument has been made for decades by some that healthcare should be based on market principles and consumers (not "patients") should be shopping around for the best deal in terms of cost and quality. Not only has the internet spawned customer service ratings, but corporate healthcare has also jumped on that as well (a family member had 144 medical appointments in 2022, including tests and therapies, every damn one of them meant a robocall from their customer survey people). For a large number of people, medical care is routine--minor illnesses and injuries and screenings. The concept of a sacred trust does not come into play except in terms of HIPAA rules and ordinary professional standards. For another segment of people, medical care is a very large part of their lives. Because scope of practice is increasingly limited, they see many more different doctors and are much less likely to have a single physician to shepherd them through all this. Marcus Welby (showing my age) would pop into the hospital to see his patient even though he was not their attending physician. That's not a thing for most people.

When it gets to be adversarial most of the time it is individual battle zones--the patient who fires doctors, the doctors who fire patients, the doctors fearing lawsuits (which very rarely end up favoring patients anyway, don't help patients with terrible outcomes that could not be helped, and only rarely are the vehicle to get rid of incompetent or unethical doctors). NONE of this is healthy for any of us.

Meanwhile the C suite in healthcare (insurance companies and hospitals) are laughing all the way to the bank.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

You prefer poor people dying quietly rather than accessing healthcare?

no i dont. insurance companies are not passing on the increase in premiums to the system. look at the insurance company salaries, have increase dramatically in the last decade but no increases to the reimbursements. this is not a joke, the docs making 250k a year 15 years ago are still getting 250k, now does that sound right?? have you seen your salary increase in the last 15 yrs? if it didn't, where would your job satisfaction be? would you recc your job to other people so they can enter the field?? the answer is no.

All I am saying is that insurance companies are allowed to do what they want and me as a doctor and you as a patient have no control what so ever. You're pissed with the quality of care, we are pissed at you being pissed not understanding what we are going through and the insurance companies are making money hand over fist at levels not seen before.

At the end, insurance companies need to pass on the profits to the system so docs are happier, more people enter the field, more patients can be seen because we have a bigger work force and quality of care goes up.

How does that work? Far more kids apply to medical than there are spots. There are more kids graduating medical school than there are internships available

[Anonymous]

Anonymous wrote:

Anonymous wrote:everyone needs to push back on insurance companies and politicians. they refused to increase reimbursement for services for the last 10-15 yrs. when reimbursements stay flat, the system needs to churn more patients which leads to all these complaints.

this is the start of socialist healthcare. when everyone is covered and they all need to be seen, quality of care goes down.

wake up to the realities of what socialism.

socialism? I am not advocating for universal health care but the status quo isn't working. For profit healthcare is not working. You want to talk about quality of care going down? How about hospitals cutting corners to make money? How about terrible nurse to patient ratios to cut costs? And in order for insurance companies to survive, they deny patients (who pay for their services) necessary care. The whole thing is a freaking mess.

Everything you just said is done because the providers and offices are getting squeezed by insurance companies so the admin staff who are not providers and have full control over the operations pass it on down to you guys as patients. This is purely an insurance issue.

in order for insurance companies to survive --> gotta be a joke, they are at RECORD profits!!!!

The insurance companies have gone as far as planting former employees in places like the ADA and AMA!!! just last week a report came out where there was negotiations with ADA and insurance companies to decide on the level of reimbursements and the amount of $$ that has to go towards providing care from the profits...guess what?? it was later discovered that the person sitting at the table for the ADA was a former delta dental employee!!! and obviously the negotiations didnt solve anything because thats not what the insurance companies want. This sort of thing is happening all the time but we just dont know.

Stand up to insurance, tell your politician enough is enough. The system is the problem and the system is insurance companies!!

[Anonymous]

Anonymous wrote:

My husband is a doctor and I'm a research scientist. I've never heard of any doctor firing a patient for asking too many questions, being annoying, or being on Medicare or Medicaid. I imagine that rarely, there are cases where a medical practice might not feel safe with a patient suffering from mental illness who has made threats or been violent... but we're not aware of this happening in our circle.

No doctor would do this unless for dire reasons. Doctors are trained to deal with all sorts of obstacles in patient care, it's part of their job. Heck, at hospital trauma centers, they deal with violent offenders and violent drug addicts all the time.

This. The MD will fire you if you have untreated or uncontrolled mental disease, including hypochondria, or if you are non-compliant about medication and appointments. Pediatrician will also drop you if you don't vaccinate the children.